title: Factors associated with disability and depressive symptoms among individuals with diabetes: a community study in Quebec.
abstract: BACKGROUND
  The prevalence of diabetes in Canada is increasing. Multiple factors have been identified in the development of disability in diabetic patients, but the interaction of those risk factors is not clear.
  
  
  OBJECTIVE
  The purpose of this paper was to assess the association between diabetes severity, health behavior, socioeconomic status, social support, depression, and disability simultaneously in a population-based study of individuals with diabetes in Quebec, Canada.
  
  
  METHODS
  Random digit dialing was used to select a sample of 2,003 adults with self-reported diabetes in Quebec. Health status was assessed by the World Health Organization Disability Assessment Schedule II and the CDC Healthy Days Measures. The Patient Health Questionnaire (PHQ-9) was used to assess depression. Potential risk factors included diabetes severity, social support, socioeconomic status, and health behavior factors. Structural equation models were used to identify risk factors that contributed to both depressive symptoms and disability.
  
  
  RESULTS
  The prevalence of major and minor depression was 8.7% and 10.9%, respectively, while the prevalence of severe disability was 6.7%. Diabetes severity and health behavior factors were associated with both depression and disability. Social support was associated with depression for women but not for men.
  
  
  CONCLUSIONS
  Our results suggest a complex interaction between health behavior factors, diabetes severity, social support, depression, and disability. Behavioral factors and diabetes-specific factors might have a direct effect on both depression and physical functioning.
authors.affiliation: Department of Psychiatry, McGill University, Douglas Mental Health University Institute, Montreal, Quebec, Canada. norbert.schmitz@mcgill.ca
authors.forename: Norbert
authors.initials: N
authors.lastname: Schmitz
authors.forename: Lyne
authors.initials: L
authors.lastname: Messier
authors.forename: Danit
authors.initials: D
authors.lastname: Nitka
authors.forename: Anna
authors.initials: A
authors.lastname: Ivanova
authors.forename: Genevieve
authors.initials: G
authors.lastname: Gariepy
authors.forename: Jianli
authors.initials: J
authors.lastname: Wang
authors.forename: Ashok
authors.initials: A
authors.lastname: Malla
authors.forename: Richard
authors.initials: R
authors.lastname: Boyer
authors.forename: Alain
authors.initials: A
authors.lastname: Lesage
authors.forename: Irene
authors.initials: I
authors.lastname: Strychar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000523:psychology*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011792:Quebec / Q000453:epidemiology; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D012923:Social Class; D012944:Social Support; D011795:Surveys and Questionnaires